Table 1.
Schematic evaluation of late effects of treatment in Wilms tumor survivors
| Morbidity | Mortality | |
|---|---|---|
| Heart disease | ||
| Congestive heart failure | cumulative incidence after 20 years: 4.4% of patients treated with DXO at initial diagnosis;102 17.4% DXO at relapse102 | |
| Subclinical cardiac abnormalities | frequency at 7 years follow-up: 24/97 (25%) of patients treated with DXO3 | |
| Any cardiovascular CHC (grade 1–5) | cumulative burden at age 50 years: 4.13 (3.57–4.69)4 | |
| Pulmonary disease | ||
| 1 or more abnormal pulmonary function test results (FEV1, VC, DLCO) and fibrosis on X-ray | cumulative incidence at 15 years: <0.5% with no RT;103 4.0% RT for initial treatment;103 5.5% RT for relapse103 | |
| Pulmonary fibrosis | >5 year follow up: 0.2%14 | |
| Any pulmonary CHC (grade 1-5) | cumulative burden at age 50 years: 1.96 (1.53–2.39)4 | |
| Renal dysfunction | ||
| End-stage renal disease (ESRD) | cumulative incidence at 20 years: 0.6% after unilateral disease;104 12% bilateral disease104 | |
| Any renal CHC (grade 1–5) | cumulative burden at age 50 years: 0.48 (0.25–0.70)4 | |
| Secondary malignant neoplasms | ||
| cumulative incidence at 15 years: 1.6% (73% within the radiation field)105 | mortality 5 years follow-up: 1.1% of deaths14 | |
| mortality >5 years follow-up: 2.7% of deaths14 | ||
| cumulative burden at age 50 years: 0.61 (0.32–0.90)4 | ||
| Reproductive health problems | ||
| Primary ovarian failure | 20/25 female survivors (80%)106 | |
| Premature menopause (<36 years) | 4/25 female survivors (16%)106 | |
| Spontaneous abortion or stillbirths | 2% of the recorded pregnancies107 | |
| Premature births (20–36 weeks of gestation) | 33.3% of children of female with WART107 | |
| Low birth weight (<2.5 kg) | 33.3% of children of females with WART | |
| Any reproductive CHCs | cumulative burden at age 50 years: 1.16 (0.82–1.49)4 | |
CHC, chronic health condition; DXO, doxorubicin; RT, radiotherapy; WART, whole abdomen radiotherapy. Cumulative incidence (%) expresses disease frequency in a given period of time. Cumulative burden expresses the mean number of recurrent/multiple health events a cohort member experiences by a given time point in the presence of competing risk events. The grades are according to the Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE): mild (grade 1), moderate (grade 2), severe/disabling (grade 3), life-threatening (grade 4), or death (grade 5).4